Sleep disturbances in young children are a common complaint among parents, and they can disrupt and put strain on not only the child but the entire family. Problematic sleep is seen to affect 20-40% of the paediatric population and to have long-term consequences; therefore it is crucial that these problems are identified early and are treated with the optimal method to ensure that children are receiving the best possible start to life and are developing to their full potential. A regular bedtime routine has been shown previously to be an important tool in improving problematic sleep in early childhood and therefore the presence of a poor bedtime routine may be an indicator of problematic sleep.

Aim: To determine the effect that daytime practices and routines around bedtime (referred to as sleep hygiene practices) have on the sleep of three- to four-year-olds in the Otago region. The study also aims to identify which aspects of sleep hygiene have the strongest influence on problematic sleep in these children.

Methods: An observational, cross-sectional cohort study of three- to four-year-olds born in Dunedin’s Queen Mary Maternity Hospital was carried out in the form of a questionnaire. The questionnaire was designed to seek information about the child’s daytime practices, routines that surround bedtime, and sleep patterns, along with information regarding both the mother’s and the father’s demographics. Problematic sleep and poor sleep hygiene were then identified using a scoring system developed by the researchers. Problematic sleep and poor sleep hygiene was defined as having a score equal to or above the 75th percentile.

Results: A total of 923 families completed and returned the questionnaire, representing a final response rate of 51.1%. Children with poor sleep hygiene routines (n=241) were twice as likely to suffer from problematic sleep as children who had good sleep hygiene routines (OR, 1.84; 95% CI, 1.18, 2.86; p<0.001). Problematic sleep was identified in 26.5% of children in the study.

A bedroom temperature not conducive to sleep was the aspect of poor sleep hygiene that was most influential on problematic sleep (OR, 15.87; 95% CI, 5.48, 45.99; p<0.001). followed by watching TV or DVDs to fall asleep, consuming caffeine before bed, and not engaging in relaxing activities before bed.

A child’s failure to fall asleep in their own bed was the aspect of problematic sleep most influenced by poor sleep hygiene (OR, 2.77; 95% CI, 1.47, 5.23; p=0.002), followed by not sleeping the entire night in their own bed.

Conclusions: The prevalence of problematic sleep in children in this study is similar to that identified in the reports of previous studies. Children with poor sleep hygiene habits are more likely to have problematic sleep; the most influential aspect of poor sleep hygiene is having a bedroom temperature that is not conducive to sleep, and the aspect of problematic sleep most influenced by poor sleep hygiene habits is a failure to fall asleep in their own bed.

The findings of this study support the implementation of good sleep hygiene habits to treat and prevent problematic sleep in three- to four-year-olds. However when prescribing the treatment of sleep hygiene, specific problematic sleep variables should first be identified and sleep hygiene treatment undertaken accordingly.

Future research is needed to provide evidence of the reliability and the validity of the developed questionnaire and scoring system. Therefore the next phase of this research should include validating the questionnaire as a probe for problematic sleep and sleep hygiene in young children. The developed questionnaire and scoring system have the potential to become valuable tools in the research of problematic sleep and sleep hygiene in the early childhood population.